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Rector T S - - 1995
The physiologic effects of ACE inhibitors often result in symptomatic relief in patients with heart failure and prevention of episodes of decompensated heart failure and ischemic events in some patients. It is important to determine if these effects, in conjunction with all other aspects of ACE inhibitor treatment, favorably alter ...
Brown E J EJ - - 1995
A total of 241 men and women with mild to moderately severe chronic heart failure (New York Heart Association functional class II [90%] or III) and a mean (+/- SD) left ventricular ejection fraction of 25 +/- 7%, entered a 24-week, prospective, double-blind, placebo-controlled trial of 10 or 20 mg/day ...
Letsou G V - - 1995
Dynamic cardiomyoplasty is a promising new technique that appears to effect symptomatic improvement in patients with NYHA class III heart failure. Objective improvement in systolic performance of the left ventricle appears small but remains to be further defined. No survival advantage has yet been realized, although this may be seen ...
Eriksson H - - 1995
At a time when deaths from coronary heart disease and stroke are markedly declining, mortality from heart failure is increasing. Heart failure is a costly and devastating disease, and throughout much of the industrialized world, escalating health-care costs constitute a serious burden on both public and private systems of financing ...
Pitt B - - 1995
Despite the findings in randomized trials of a significant effect of angiotensin-converting enzyme (ACE) inhibitors in reducing morbidity and mortality of patients with symptomatic left ventricular dysfunction, the morbidity and mortality of these patients remains relatively high. One potential strategy to further improve morbidity and mortality in these patients is ...
Ramahi T M - - 1995
The past two decades have witnessed tremendous advances in the pharmacologic therapy of patients with left ventricular dysfunction and chronic heart failure. The pharmacologic repertoire has been and continues to be expanded with newer agents carefully subjected to the rigor of well-designed clinical trials. Treatment has consequently evolved from pathophysiologically ...
Francis G S - - 1995
Heart failure is not a distinct disease, but rather a complex clinical syndrome that can result from virtually any form of heart disease. The so-called "end stages" of heart failure do not respect etiologic boundaries. Patients are characterized clinically by extreme cardiomegaly, breathlessness, and fluid retention. Despite recent advances in ...
Vitarelli Antonio - - 1995
In most elderly patients, cardiac failure is associated with multiple cardiac pathologies, and the most common underlying abnormality is ventricular systolic dysfunction with reduced ejection fraction. In patients without cardiac enlargement, diastolic dysfunction may be predominant and left ventricular ejection fraction may be normal. Echocardiography is particularly suitable to evaluate ...
Vitarelli A - - 1995
The available data suggest that digitalis improves symptoms of a failing heart in the presence of sinus rhythm as well as supraventricular arrhythmias. Intravenous digitalis administration in patients with chronic heart failure and baseline hemodynamic deterioration increases cardiac index and reduces heart rate. These beneficial effects are maintained with long-term ...
Fromm R E RE - - 1995
Congestive heart failure (CHF) and pulmonary edema are major health problems in the United States as well as across the rest of the developing world. The prevalence of CHF and pulmonary edema in the general population results in a significant number of these patients presenting to Emergency Departments (EDs). Mortality ...
Paul M - - 1995
The local effects of angiotensin II (ANG II) on the heart may play an important role for the pathophysiology of cardiovascular disease. Numerous in vitro studies have demonstrated that angiotensin II has distinctive cellular effects in the cardiovascular system which are independent from its effects on blood pressure. These have ...
Morooka S - - 1995
Although the pathophysiology of heart failure progression is important to survival it is not fully understood. In 92 patients with acute heart failure due to myocardial infarction or dilated cardiomyopathy, secondary organ dysfunction was evaluated to determine whether this factor contributed to heart failure progression and death. Forty-one patients had ...
van Zwieten P A - - 1994
A survey is given of the currently used therapeutics in the treatment of chronic congestive heart failure. Symptomatic treatment is usually performed along the following lines: rest, sodium and fluid restriction to unload the decompensating heart, loop diuretics, angiotensin-converting enzyme inhibitors or other vasodilators; inotropic agents to improve the heart's ...
Wheeldon N M - - 1994
Diastolic heart disease is common and appears to be the primary abnormality in a substantial proportion of all patients with CHF. The epidemiology and natural history of the condition appears different to that of systolic heart failure, resulting in significant morbidity although contributing little to overall mortality. Clinical assessment alone ...
Nussberger J - - 1994
Early treatment with ACE inhibitors of even moderate heart failure is clinically beneficial, even though haemodynamic measurements cannot adequately quantitate such improvement. Neurohumoral assessment is, however, supposed to be more accurate. In 55 patients with moderate heart failure (ejection fraction < or = 35%), we investigated the dose-dependent effects of ...
Brilla C G - - 1994
The Framingham heart study has shown that arterial hypertension is the major aetiological factor for the development of heart failure. In the presence of heart failure, various regulatory systems may be operative. These include the Frank-Starling mechanism, the neurohormonal system, regulation of cardiac growth and peripheral oxygen delivery. Recently, the ...
Kottkamp H - - 1994
Ventricular arrhythmias are a frequent finding in patients with heart failure, and heart failure is a major underlying condition which is correlated to sudden death. Therefore, both sudden death and death from progression of heart failure strongly overlap. Besides long-term ECG recording, newer diagnostic techniques have been developed. The prognostic ...
Pogwizd S M - - 1994
Our understanding of the electrophysiological and biochemical mechanisms underlying malignant ventricular arrhythmias in the setting of heart failure has been limited, in large part because of the lack of experimental preparations of heart failure that demonstrate spontaneously occurring ventricular arrhythmias. Recent 3-dimensional cardiac mapping studies in experimental preparations of heart ...
Tuininga Y S - - 1994
OBJECTIVE: To review the importance of heart rate variability analysis in left ventricular dysfunction and heart failure and to assess the effects of drug treatment. In patients with left ventricular dysfunction or heart failure, a low heart rate variability is a strong predictor of a low probability of survival. Because ...
Remme W J - - 1994
Neurohormonal activation is one of the major determining factors in the process of transition from asymptomatic ventricular dysfunction to end-stage heart failure, in the prognosis of heart failure, and in the efficacy and, hence, choice and timing of pharmacological therapy. Although various counteracting hormonal systems are involved, emphasis in terms ...
- - 1994
For over 25 years diuretics have provided the mainstay of treatment for patients with heart failure. They reduce symptoms in both acute and chronic failure, rarely need to be stopped because of unwanted effects and cost very little. The overall effect of diuretic therapy on long-term mortality is not known, ...
Dracup K K UCLA School of Nursing - - 1994
This article reviews the role of counseling, education, dietary modifications, and exercise for patients with heart failure due to left ventricular systolic dysfunction. We reviewed studies published in English between 1966 and 1993 and referenced in MEDLINE or EMBASE. We used the search terms heart failure, congestive; congestive heart failure; ...
Baker D W DW Health Sciences Program, RAND, Santa Monica, - - 1994
This review of the pharmacologic treatment of heart failure due to left ventricular systolic dysfunction summarizes the recommendations of the expert panel for the Agency for Health Care Policy and Research Heart Failure Guideline. It provides specific advice to help guide practitioners through clinical decision making. Data were obtained from ...
Remme W J - - 1994
In contrast to cyclic AMP-dependent positive inotropes, the calcium-sensitizer and partial phosphodiesterase (PDE) inhibitor pimobendan may induce beneficial effects in heart failure. However, its effect on relaxation, myocardial energetics and neurohormones are unknown. Twelve patients with heart failure, New York Heart Association (NYHA) classification II-III, due to ischemic cardiomyopathy, were ...
Coats A J - - 1994
Clinical evidence accumulated over the past decade suggests that neurohormonal mechanisms significantly influence the pathogenesis and eventual outcome of congestive heart failure (CHF). Pharmacologic modulation of this neuroendocrine activity can, consequently, be expected to improve patient prognosis. Results of several recent clinical trials--the Studies of Left Ventricular Dysfunction (SOLVD), the ...
Williams R E - - 1994
Selective and specific changes in gene expression characterize the end-stage failing heart. However, the pattern and relation of these changes to evolving systolic and diastolic dysfunction during development of heart failure remains undefined. In the present study, we assessed steady-state levels of mRNAs encoding a group of cardiac proteins during ...
Hobbs R E - - 1994
The prevalence of and mortality from congestive heart failure increase with advancing age. The most important prognostic indicators are exercise tolerance and left ventricular function. Currently, drug treatment consists of digitalis, diuretics, and ACe inhibitors. Future management may include medications to modulate the extracardiac mechanisms of decompensation and newer surgical ...
Cody R J - - 1994
Angiotensin-converting enzyme inhibitors are proved, effective agents for the treatment of hypertension and congestive heart failure. New data suggest that angiotensin-converting enzyme inhibitors may be effective therapy for patients following acute myocardial infarction. Results from clinical trials, such as the Survival and Ventricular Enlargement trial, have demonstrated that captopril attenuates ...
Cody R J - - 1994
The use of diuretics for the treatment of sodium retention in congestive heart failure was evaluated. Particular focus was given to the altered renal response to diuretics in patients with heart failure and adverse responses to diuretic therapy. Highlighted information included historical aspects of the development of diuretics, mechanisms of ...
Kleber F X - - 1994
Cardiovascular diseases are the leading causes of morbidity and mortality in the industrialized world and have become a major economic burden. Therefore, not only ethical and medical but also economic reasons suggest more intense efforts in primary and secondary prevention of cardiovascular and, especially, coronary artery disease. The prevention of ...
Francis G S - - 1994
The treatment of patients with congestive heart failure is predicated on an underlying knowledge of the pathophysiology of the syndrome. To date, the most effective therapy has been a combination of diuretics and ACE inhibitors. However, there are specific situations where direct-acting vasodilator therapy is helpful as adjunctive or replacement ...
Leier C V - - 1994
Electrolyte disturbances are a common complication of CHF. CHF provides a perfect milieu for the development of these disturbances; renal dysfunction, elevation of neurohormonal substances, activation of the renin-angiotensin-aldosterone axis, and diuretic therapy represent the major contributory factors. Hyponatremia is closely aligned with an unfavorable clinical course. Hypokalemia is associated ...
Wilde M I - - 1994
Enalapril is an angiotensin converting enzyme (ACE) inhibitor with an established clinical profile. In patients with symptomatic heart failure, enalapril reduces overall mortality, death from progressive heart failure and hospitalisation rates. In those with asymptomatic left ventricular dysfunction, enalapril decreases the combined risk of death and development of heart failure, ...
Giles T D - - 1994
The introduction of new drugs, and a re-evaluation of older drugs, have radically changed the pharmacological management of heart failure. Angiotensin converting enzyme (ACE) inhibitors, digitalis, diuretics and the combination of nitrates and hydralazine are now used. The first Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS I) and the second ...
Struthers A D - - 1994
Since the United Kingdom has fewer cardiology specialists than other countries, the United Kingdom cardiologist cannot provide direct care for all patients with chronic congestive heart failure (CHF). Most CHF care is provided by general practitioners, physicians or geriatricians. A survey of 100 CHF patients attending a health center revealed ...
DiBianco R - - 1994
EPIDEMIOLOGY: Risk factors for heart failure vary in magnitude, depending on age and sex. Incidence, prevalence, morbidity and mortality are strongly age-related. The presence of hypertension or diabetes among men aged 35-64 years increases the risk fourfold. Electrocardiographic evidence of left ventricular hypertrophy in this group increases the risk 15-fold, ...
Drexler H - - 1994
Myocardial hypertrophy is an established risk factor for cardiovascular morbidity and mortality. Beyond quantitative and mechanical aspects hypertrophy is associated with alterations in cardiac gene expression, resulting in a more fetal-like myocyte phenotype with a fragile Ca++ homeostasis. Depressed expression of sarcoplasmatic reticulum ATPase is the hallmark of this overload ...
Dupuis J - - 1994
Nitrates are commonly used in the therapy of congestive heart failure (CHF). They exert beneficial hemodynamic effects by decreasing left ventricular filling pressure and systemic vascular resistance while modestly improving cardiac output. The improvement in left ventricular function caused by nitrates is the result of combined reduction in outflow resistance ...
Ray S - - 1994
Angiotensin converting enzyme (ACE) inhibitors are effective across the whole spectrum of heart failure from mild to severe but there are little data on the use of ACE inhibitors specifically in patients with postinfarct heart failure. Pharmacological properties that might potentially be relevant to the choice of drug after myocardial ...
- - 1994
More than 2 million Americans have heart failure, and about 400,000 new cases are diagnosed each year. Mortality is high, with 5-year mortality in the range of 50 percent. Many of the almost 1 million hospitalizations each year for heart failure might be prevented by improved evaluation and care. This ...
- - 1994
More than 2 million Americans have heart failure, and about 400,000 new cases are diagnosed each year. Mortality is high, with 5-year mortality in the range of 50 percent. Many of the almost 1 million hospitalizations each year for heart failure might be prevented by improved evaluation and care. This ...
Francis G S - - 1994
The past few years have witnessed an extraordinary number of important developments in the study of compensatory and maladaptive responses to cardiac dysfunction. It now seems clear that the process whereby the heart remodels in response to left ventricular injury is of paramount importance in the expression of clinical heart ...
Fitton A - - 1994
Pimobendan is a novel cardiotonic vasodilator (inodilator) which derives its inotropic activity from a combination of phosphodiesterase III inhibition and sensitisation of myocardial contractile proteins to calcium. The acute haemodynamic benefits of pimobendan (2.5 to 10mg orally; 5 to 10mg intravenously) seen in patients maintained on conventional diuretic, digitalis and ...
Feldman A M - - 1994
During the past year, several important studies have strongly supported the use of what we now view as the three-pronged, "standard" approach to the treatment of symptomatic heart failure: diuretics, digoxin, and angiotensin-converting enzyme inhibitors. New information regarding the latter two agents is reviewed elsewhere in this issue of Current ...
Wu H - - 1994
Since only oral preparations of captopril are clinically available, intravenous captopril was studied in 10 patients with mild heart failure and in 20 severe. The results showed that intravenous captopril may rapidly reduce cardiac preload and afterload, increase cardiac output, inhibit renin-angiotensin-aldosterone system, and depress plasma levels of catecholamine. After ...
Pouleur H - - 1994
Measurements of plasma neurohormones in patients with left ventricular dysfunction are generally performed for research purpose rather than for diagnostic purpose or to guide therapy. These studies have shown that in patients with left ventricular dysfunction, several neurohormonal systems were activated, even in the absence of symptoms of congestive heart ...
Ball S G - - 1994
Unlike most cell-types in the body, cardiomyocytes do not replicate in adult life. Consequently myocardial infarction produces irreparable damage to the heart which in turn increases the likelihood of premature death. Recent trials indicate that immediate aspirin and thrombolytic therapy beneficially modify the natural history of myocardial infarction, reducing both ...
Cohn J N - - 1994
Emphasis on the management of heart failure has shifted from attempts to alter hemodynamics and symptoms to attempts to interfere with the natural history of the disease. This shift in emphasis has been stimulated by the recognition that heart failure progresses despite therapy and that shortened life expectancy makes the ...
Conti C R - - 1994
One can summarize the current status of calcium antagonists to treat heart failure as follows: Usually there is a favorable acute response to these drugs in heart failure patients but long-term effects in the patients treated with nifedipine, diltiazem, and verapamil have produced rather disappointing results. Thus, they should not ...
Zimmer H G - - 1994
It is remarkable that the heart, which obviously functions as a homogenous pump, shows such a high degree of heterogeneity. There are often contradictory or controversial results as far as transmural gradients are concerned (78). These discrepancies or inconsistencies, however, can at least in part be explained by species differences. ...
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